BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.

Homocystemia is a pathological condition that represents a significant role in cardiovascular morbidity and mortality. The epidemiology, pathophysiology, and clinical diagnostics and treatment aspects are described and discussed.

Introduction: The evaluation of Florida Primary Care Physicians' knowledge with the most common misdiagnoses and the possible impact of Continuing Medical Education (CME) classes on that knowledge will prove beneficial to physicians and health care personnel concerned with quality control and education of proper practices in the health care setting.Methods: An anonymous survey was created and sent via email to 551 licensed Internal Medicine and Family Practice physicians. The questions tested physician's knowledge of the most common misdiagnoses and the breakdown points resulting in misdiagnoses. The Rasch model was used to analyze subject's responses. The survey was sent to 551 physicians, 179 of whom responded. Of those who responded, 47.5% have a private practice, 71% are over the age of 45, and 90% are Board certified. The majority of physicians surveyed (55.4%) had over 16 years in practice. These figures mirror those of the general physician population in the state of Florida. Results: Of the 179 physicians (32.5% response rate) who completed the survey, 40% correctly identified Pulmonary Embolism as the most commonly misdiagnosed condition (in terms of relative incidence) but only 7% of physicians correctly identified infections as the most common misdiagnosis (in terms of total incidence). Interestingly, 58% of physicians understood that breast cancer is the most commonly misdiagnosed, which leads to malpractice. Conclusion: Most physicians are not aware of the most common misdiagnosis or of the most common process errors, which lead to misdiagnoses. Yet, physicians seem to be better informed about misdiagnoses that commonly lead to malpractice. This may be a result of physician bias, or a deficiency on the part of continuing medical education courses to present empirical material on the most common misdiagnosed conditions.

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